Relapsing-remitting clinical course expands the phenotype of Aicardi-Goutières syndrome

Abstract

Aicardi-Goutières syndrome (AGS) is a rare and likely underdiagnosed genetic leukoencephalopathy, typically presenting in infancy with encephalopathy and characteristic neuroimaging features, with residual static neurological deficits. We describe a patient who, following an initial presentation at the age of 12 months in keeping with AGS, exhibited a highly atypical relapsing course of neurological symptoms in adulthood with essentially normal neuroimaging. Whole-exome sequencing confirmed a pathogenic RNASEH2B gene variant consistent with AGS. This case highlights the expanding phenotypes associated with AGS and the potential role of whole-exome sequencing in facilitating an increase in the rate of diagnosis.

Figure 1

MRI findings. Neuroimaging (T2 fluid‐attenuated inversion recovery [FLAIR]) of the patient performed at 30 years of age (A–F: axial views [A–C: level of medulla oblongata, pons, and midbrain, respectively]; G–I: sagittal views), demonstrating scattered small foci of hyperintensity within the periventricular and subcortical white matter (indicated by arrows).